Editor's note: The following is part one of a two-part blog entry written by Patty Roth of Alexandria. She's deployed in Afghanistan as a critical care nurse in charge of the intensive care unit at the Kandahar NATO Role 3 Hospital. It is only lightly edited for length and the newspaper added the subheads. The entry was provided by her husband, Todd Roth. He notes, "I think it is important to not forget that we still have those overseas in danger. I pray they will all be home soon safely."

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This post is about one particularly hard day, meant only to give you a glimpse of what it is like here and how we cope with what we see.

It was 0830 and I was in my office working on some useless spreadsheet when my pager went off. It said "Ax1, GSW APH ETA 10 m." This translates to incoming...one injured, life threatening (Alpha), Gun Shot Wound, coming by Apache Helicopter, Estimated Time of Arrival, 10 minutes.

With that message, our trauma team quickly went down to the trauma bay to take our places to accept this patient. I decided to go down to the trauma bay myself to see if there was anything that I could do to help. While the patient was being unloaded at the flight line, the flight medic came in to give a quick report. I had seen this flight medic before, and he had always been cool as a cucumber, but he appeared shaken as he gave this report: "30-something year old male was out on patrol with his Seal team, and took a sniper round to the head. Unable to secure an airway in the field so a surgical tracheotomy was placed. He lost a lot of blood, the second unit of blood is hanging."

A BULLET TO THE HEAD

As they rolled the patient in, I noticed there was blood dripping off of the litter. The trauma team quickly rolled him to get him off the litter and on to our gurney, and I noticed the bullet entrance wound right above his right eye, and as we turned him, the exit wound was on his left side, right behind his ear. I noticed that the patient was posturing decordecate (for those of you non-medical types, this is very bad...usually meaning that the brain is swelling and pushing down the spinal column, and if not moved on quickly, will lead to brain death). I knew that if we didn't move quickly, this patient would surely die.

Within seven minutes of being in the trauma bay, the patient was headed out to the OR. My two ICU nurses who were in charge of hanging blood went with to the OR to continue to infuse blood. I decided to head back to the ICU to see if they needed any help and to make sure that everyone got a chance to eat, because without a doubt, this patient would be coming to the ICU...if he survived surgery.

THE PATIENT'S BUDDIES

While the patient was in surgery, I had to go across the hall to the ward to get some supplies, and I noticed about 10 guys sitting outside the ICU, heads in their hands. I knew that these guys had to be the buddies of the patient. I asked them if they were OK, but they just looked bewildered. They told me that they are part of a Seal team and they needed to know how he was doing.

They asked me if I knew anything about how the surgery was going. I told them that I didn't know, but I would try to find out for them. On the civilian side of nursing, I would not be able to give any information out to buddies, only immediate family, but it is different in the military. These guys are his family; they are his brothers.

TOUCH AND GO

I went to the OR, and talked to one of the OR nurses that was in and out of the room trying to help. She said it was touch and go at best...not good. I said a little prayer, and then went back out to tell the guys what I had learned.

These are always the hardest conversations, but I have learned that even if it is hard to say, it is always best to tell them the truth. So, I told them that it was still touch and go, that we were doing everything that we could to save him, and all we could do was pray.

I called the chaplain and we all stood in a circle in the middle of the hall way and said a very heartfelt prayer. I then went back in the ICU to help out some more, but I kept going back out to the guys to see if I could get them any food or anything to drink. By this time it was about noon, and I knew that they probably hadn't even had breakfast yet, but the food I brought remained untouched.

At 1330 we got word that he would be coming out of surgery in about five minutes. I went and told the guys, but asked them to give us 10 minutes just to settle him before we let them in to see him.

AFTER SURGERY

When the surgery team rolled through the door with the patient, it just took one look at the neurosurgeon to know how surgery had gone. The nurses that had been infusing blood looked defeated. "Oh crap," I thought.

The surgeon had performed a craniectomy, where he totally removed almost half of the patient's skull to allow the brain to swell, trying to prevent herniation and brain death. But the surgeon said when he removed the skull, the brain started to swell and bleed profusely. They had given him 34 units of blood, 27 units of FFP, four units of platelets, two units of Cryo, and a medication called TXA used to help with clotting.

The surgeon said he did the best he could to stop the bleeding, but was unsure if he would survive. Only time would tell...he was still very unstable. The pressure in his head was still extremely high, and we had to start medication to bring his blood pressure up so that he could continue to perfuse his brain.

TEARS AND RESPECT

We let the guys come in to see the patient, but told them that we needed them to be quiet because any stimulation would increase his pressure in his head even more. The guys were very respectful, never in the way...but never far away from their brother, either.

There were tears from all of them, but they were silent. They circled around each other, supporting each other, silently crying. This was so hard to see because these guys are Seals. They think they are invincible. They are the elite fighting force. They are young and they are Navy. I did my very best to hold it together, but there were more than a few tears that streamed down my face.

It also was becoming clearer and clearer to me that there was not going to be a good outcome. His pupils were dilated and unresponsive, and he was not moving anything. In my gut, I knew that he had already herniated.